| NPI | 1114471638 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401224911) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 2900) |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2025-02-14 |